Cervical Screening Programme, England. Statistics for

Transcription

1 Cervical Screening Programme, England Statistics for Published 10 November 2015

2 We are the trusted national provider of high-quality information, data and IT systems for health and social care. This report may be of interest to members of the public, policy officials and other stakeholders to make local and national comparisons and to monitor the quality and effectiveness of screening services. Author: Responsible Statistician: Screening and Immunisations Team, Health and Social Care Information Centre Pritpal Rayat, Section Head Version: V1.0 Date of publication: 10 November Copyright 2015, Health and Social Care Information Centre. All rights reserved.

3 Contents This is a National Statistics publication 5 Executive Summary 6 Introduction Background Cervical Screening Process Quality Statement Report Structure Changes to the Report User Feedback 12 Analysis and Commentary 13 Call and Recall Programme Coverage Invitations for screening Test results Time from screening to receipt of results Recall status 29 Cervical Cytology Samples examined Results Outcome of gynaecological referrals Achievable standards for laboratory reporting 38 Colposcopy Referrals for colposcopy Appointments for colposcopy First Attendances at colposcopy Biopsies Clinic data 51 Appendices 52 Appendix A Glossary 52 Appendix B Definitions 55 Appendix C Types of Invitation 59 Appendix D Cytology Test Result Categories 60 Copyright 2015, Health and Social Care Information Centre. All rights reserved. 3

4 Appendix E Outcomes of Gynaecological Referral 62 Appendix F How are the Statistics Used? 63 Appendix G Feedback from Users 66 Appendix H - Data Validation and Data Quality 67 Appendix I Related Publications and Useful Web Links 70 References 71 4 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

5 This is a National Statistics publication The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics: meet identified user needs; are well explained and readily accessible; are produced according to sound methods; and are managed impartially and objectively in the public interest. Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed. Find out more about the Code of Practice for Official Statistics at Copyright 2015, Health and Social Care Information Centre. All rights reserved. 5

6 Executive Summary Cervical Screening Programme, England, Statistics for Women between the ages of 25 and 64 are invited for regular cervical screening under the NHS Cervical Screening Programme. This is intended to detect abnormalities within the cervix that could, if undetected and untreated, develop into cervical cancer. This report presents information about the NHS Cervical Screening Programme in England in as well as key statistics from the previous ten years. It includes statistics on the call and recall programme for women aged 25 to 64 years, as well as statistics on screening samples examined by pathology laboratories and on referrals to colposcopy clinics. The statistics in this report are used to inform policy and to monitor the quality and effectiveness of screening services. They are derived from information that is routinely collected by the NHS Cancer Screening Programmes for the operation of the screening programme, including quality assurance and performance management purposes. The statistics are presented at England level and by Upper Tier Local Authority (LA), region, pathology laboratory and colposcopy clinic. Main Findings Call and Recall Programme Coverage is defined as the percentage of women in a population eligible for screening at a given point in time who were screened adequately within a specified period (within 3.5 years for women aged 25 to 49, and within 5.5 years for women aged 50 to 64). This is known as age-appropriate coverage and is also used in the Public Health Outcomes Framework (PHOF) 1. At 31 March 2015, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 73.5%. This compares with 74.2% at 31 March 2014 and 75.7% at 31 March Coverage amongst women aged 25 to 49 years (measured at three and a half years) was 71.2 % at 31 March This compares to 71.8% as at 31 March 2014 and 73.7% as at 31 March For women aged 50 to 64 years, the coverage (measured at five and a half years) at 31 March 2015 was 78.4% which compares to 79.4% as at 31 March 2014 and 80.1% as at 31 March See and for more information. 6 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

7 At a regional level, coverage of the full target age group (25 to 64 years) at 31 March 2015 ranged from 68.4% in London to 76.3% in the East Midlands. This compares to 70.3% in London and to 76.6% in the East Midlands at 31 March At a local level, 63 Local Authorities (out of 150) had coverage levels of 75% and above. A total of 4.31 million women aged 25 to 64 were invited for screening in and 3.12 million women were tested, representing a fall of 3.3% from when 3.23 million were tested. Amongst women aged 25 to 64 with adequate tests in , 93.6% had a negative result and 6.4% had a result categorised as abnormal (from borderline change through to potential cervical cancer). 1.3% of women tested in had a result showing a high-grade abnormality. National policy is that all women should receive their cervical screening test result within 2 weeks of the sample being taken. In , 91.0% of letters sent to women tested were reported to have an expected delivery date of within 2 weeks of the sample being taken. This compares to 93.7% in and is below the Key Performance Indicator current acceptable value of 98.0% 2. At a regional level, the highest percentage of letters received within 2 weeks of results was reported in the North East (98.6%), with the lowest in Yorkshire & the Humber (81.5%). As such, the North East is the only region to have met the Key Performance Indicator current acceptable value of 98.0% in Cervical cytology 3.20 million samples were examined by pathology laboratories in This compares with 3.41 million in Of the samples examined in , 3.04 million samples (94.8%) were submitted by GPs and NHS Community Clinics, of which 2.5% were inadequate. This compares with 2.4% in Colposcopy A total of 198,216 referrals to colposcopy were reported in , a slight fall of 0.6% from (199,322 referrals). In , where women were referred to colposcopy, 30.9% were offered an appointment within 2 weeks of referral. This percentage rose to 61.0% for those offered an appointment within 4 weeks and to 97.3% for those offered an appointment within 8 weeks. 2 NHS public health functions agreement Service specification no.25 Cervical Screening Copyright 2015, Health and Social Care Information Centre. All rights reserved. 7

8 Introduction This report presents information about the NHS Cervical Screening Programme in England in as well as key statistics from the previous ten years. It includes statistics on the call and recall programme for women aged 25 to 64 years, as well as statistics on screening samples examined by pathology laboratories and on referrals to colposcopy clinics. The publication includes analysis and commentary, a set of data tables and a number of appendices, including a Glossary of terms. The report focuses on England but also includes regional comparisons, local coverage statistics and coverage from other UK countries. The statistics in this report are used to inform policy and to monitor the quality and effectiveness of screening services. This publication has been in existence for a number of years and electronic copies of the publications are available dating back to The report was originally published by the Department of Health (DH) Statistics Division. Responsibility for the publications transferred from DH to the Health and Social Care Information Centre (HSCIC) when it was formed in Background Cervical Screening Policy Women between the ages of 25 and 64 are invited for regular cervical screening under the NHS Cervical Screening Programme. This is intended to detect abnormalities within the cervix that could, if undetected and untreated, develop into cervical cancer. National policy is that women are offered screening every three or five years depending on their age. Women aged are invited for routine screening every 3 years, whereas those aged are invited for routine screening every 5 years. In this bulletin, the current target group of 25 to 64 years is used to report statistics Data Sources The statistics are derived from information that is routinely collected by the NHS Cancer Screening Programmes (NHSCSP) for the operation of the screening programme, including quality assurance and performance management purposes. Information on the NHS Cervical Screening Programme is collected on the following HSCIC Korner Collection (KC) returns: 3 The Health and Social Care Information Centre was known as The Information Centre in Copyright 2015, Health and Social Care Information Centre. All rights reserved.

9 KC53 information from the call and recall system, collected on all 152 Upper Tier Local Authorities operating in KC61 information on screening samples examined by pathology laboratories, collected from all laboratories carrying out cervical cytology. At 31 March 2015, 59 laboratories were carrying out cervical cytology. KC65 information on referrals to colposcopy, subsequent treatment and outcome, collected from 199 clinics/trusts providing colposcopy services. Further information on the underlying sources of information can be found in the separate Quality Statement 4 and in HSCIC s List of Administrative Sources Cervical Screening Process The cervical screening process falls into three main parts: Call and recall programme Most women invited by the screening programme have their initial screening test at either their GP practice or an NHS Community Clinic. The standard age ranges and frequency of screening are detailed above. Women aged 65 or over are ineligible for routine screening and are removed from the call/recall programme if they have a satisfactory screening history. It is possible for some women outside the 25 to 64 years age range to be invited for screening. Women aged 65 or over who have never been screened and those whose last three tests were not normal are still eligible for screening. Women over 65 who require follow-up after treatment also continue to be included in the programme. In addition, women are now routinely invited shortly before their twenty-fifth birthday to ensure they can have their first screen at about age Cervical cytology Samples from the testing process are passed to pathology laboratories for slide preparation and screening by a cytologist/screener. The results of each test are returned to the call/recall department, the woman s GP and the sample taker (if not the GP). Women should be notified of their test results in writing within two weeks. Most women receive a normal result and are recalled for another routine test in three or five years dependent on their age. Where a test result shows borderline change or low-grade dyskaryosis (abnormal cell changes), women are tested for infection with high-risk HPV (Human Papillomavirus). HPV is a common virus which, although harmless in most women, 4 Available through the following link: 5 Available through the following link: Copyright 2015, Health and Social Care Information Centre. All rights reserved. 9

10 is linked to the development of abnormal cervical cells. If left untreated, these abnormal cells can develop into cervical cancer. Women whose samples test positive for HPV are referred to colposcopy 6. Where the HPV test is negative women are recalled for screening in three or five years as usual. HPV testing as triage (sorting) for women with borderline and low-grade dyskaryosis results became routine from 1 April In a small proportion of cases the pathology laboratory is unable to assess the cells on the cytology slide to give a result and the test is considered inadequate. In such cases women are asked to return for a repeat test three months later Colposcopy Women referred for colposcopy attend a colposcopy clinic where a colposcope (a lighted, low-powered microscope) is used to closely examine the cervix to determine appropriate treatment, if any. A biopsy may be taken from the cervix for diagnosis and/or the cervix may be treated. Women who do not require immediate treatment may be kept under surveillance by repeat cytology tests, with or without repeat colposcopy, at suitable intervals. 1.3 Quality Statement The Quality Statement presents information to aid understanding and presentation of the data. This is now published as a separate document on the publication webpage which can be accessed via the following link: Report Structure Statistics from the NHS Cervical Screening Programme are presented in the Analysis and Commentary section of this report in three sub-sections as follows: Call and Recall Programme Cervical Cytology Colposcopy In presenting laboratory statistics in the Cervical Cytology section, data about samples from GP and NHS Community Clinics have been used in most tables in preference to data about samples from all sources, so as to reflect more closely the results from screening programme tests delivered in primary care. 6 Where HPV Primary Screening is being piloted, women are first tested for HPV. If the sample is found to be positive, it is then examined by the cytologist for any abnormal cells. 10 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

11 1.4.3 The Appendices include: A Glossary to aid understanding of technical terms (Appendix A) An explanation of useful Definitions (Appendix B) Types of invitation (Appendix C) Cytology test result categories (Appendix D) Outcomes of Gynaecological Referral (Appendix E) How the Statistics are Used (Appendix F) Feedback from Users (Appendix G) Information on Data Validation and Data Quality (Appendix H) Related Publications and Useful Web links (Appendix I). 1.5 Changes to the Report Headline coverage figure A policy change in 2003 meant that women aged were to be invited for screening every three years instead of at intervals of not more than five years. As a result the accepted definition for overall coverage of the age group is for eligible women aged to be adequately screened in the last 3.5 years, and for eligible women aged to be adequately screened in the last 5.5 years (see the Coverage section of Appendix B for further detail). The KC53 return, the historic data source for cervical screening coverage, does not allow for this calculation, and as such this report has previously presented the headline coverage figure using the earlier definition. That is eligible women aged screened adequately with 5 years, referred to as 5 year coverage in this report. Since 2011, an alternative data extract from the same call / recall system has been run by the HSCIC for the Public Health Outcomes Framework (PHOF) online reports 7. This extract is derived from the Open Exeter system and uses the more up to date definition for coverage outlined above, referred to as Age appropriate coverage in this report. In , this report included this data for the first time, but continued to report 5 year coverage as the headline figure. As of this year s report, age appropriate coverage will instead be used for the headline figures. 5 year coverage will continue to be presented in some tables and charts in order to present a longer time series. As the KC53 return provides more detailed coverage information than the PHOF extract (for example lower level age bands), it is still used for other analysis within the report. Within the report readers will see changes to Tables A, B and D, and to Figures 1, 3 and 3a. As mentioned above, these changes are represented by the shift in focus to the age appropriate coverage figure also used in the PHOF. Abnormal Predictive Value (APV) A new section on APV (see section 3.4.4), which is one of the achievable standards for laboratory reporting, has been added to the report this year. 7 Copyright 2015, Health and Social Care Information Centre. All rights reserved. 11

12 Data Presentation Figures 12 and 13 that previously showed the outcome of referral following (i) non-negative test result (persistent or with positive HPV test) and (ii) single occurrence of potential significant abnormality respectively have been changed to a clustered bar chart showing both categories, under Figure 12. Data Tables Please note that the Data Tables have been removed from this report but are available in an Excel print friendly file from User Feedback The HSCIC welcomes feedback on all publications. If you wish to comment on this report a feedback form (Have Your Say) is available on the HSCIC website at: We would be particularly interested in how you use the statistics in this report. Feedback received from users via the publication webpage is summarised in Appendix G along with any action that has been taken as a result of this feedback. 12 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

13 Analysis and Commentary Call and Recall Programme 2.1 Coverage Coverage is defined as the percentage of women in a population eligible for screening at a given point in time who were screened adequately 8 within a specified period. As the frequency with which women are invited for screening is dependent on age, coverage is calculated differently for different age groups. For those aged 25 to 49, coverage is calculated as the percentage of women eligible for screening who have had an adequate screening test within the last 3.5 years on 31 March For those aged 50-64, coverage is calculated as the percentage of women eligible for screening who have had an adequate screening test within the last 5.5 years (see Table A). For the total target age group (25 to 64 years), two definitions of coverage are presented in this report. Age-appropriate coverage represents the most up to date definition and takes into account the frequency with which women of different ages are invited for screening, and defines coverage as the percentage of women in the population eligible for cervical screening who were screened adequately within the previous 3.5 years or 5.5 years, according to age on 31 March This is the definition used for the headline coverage figures. Five year coverage represents an earlier definition and measures the percentage of women in the population eligible for cervical screening who have had an adequate test within the last 5 years on 31 March It is retained in this report to present a longer time series for comparison. More detailed definitions and explanations of the different measures of coverage are given in the Coverage section of Appendix B Age appropriate coverage ` At 31 March 2015, the percentage of eligible women (aged 25 to 64) who were recorded as screened adequately within the specified period was 73.5%. This compares with 74.2% at 31 March 2014 and 75.7% at 31 March Coverage amongst women aged 25 to 49 years (measured at three and a half years) was 71.2% at 31 March This compares to 71.8% as at 31 March 2014 and 73.7% as at 31 March For women aged 50 to 64 years, the coverage (measured at five and a half years) at 31 March 2015 was 78.4% which compares to 79.4% as at 31 March 2014 and 80.1% as at 31 March In a small proportion of cases the pathology laboratory is unable to assess the cells to give a result and the test is considered inadequate. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 13

14 Data on age-appropriate coverage is only available for the last five years but shows a fall in coverage at 31 March 2015 following a rise in the previous year Five year coverage Five year coverage at 31 March 2015 for women aged was 77.2% compared with 77.8% in This measure of coverage will always be higher than the age appropriate definition as women aged who were not screened within the last 3.5 years but were screened within the last 5 years are counted under this definition but not under age appropriate coverage. The long term trend shows a gradual fall in five year coverage over the last ten years. Apart from an increase in 2009, which has been associated with the media attention around the diagnosis and subsequent death of the high profile media personality, Jade Goody (Poole et al, 2012), coverage has either fallen or remained unchanged each year since 2005 (see Figure 1 and Table A). Figure 1: Cervical screening Coverage by age group (25-64) England at 31 March, 2005 to 2015 Percent Coverage - age appropriate (less than 3.5 / 5.5 yrs since last adequate test) 5 year coverage (less than 5 yrs since last adequate test) Year 2006 data as at 10th August 2006 Age-appropriate coverage at 31 March 2013 excludes some women from a small number of LAs. Source: KC53 return (5 year coverage) and Open Exeter (age appropriate coverage). Health and Social Care Information Centre. See also Tables 1, 1a and 13 in Data Tables section. 14 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

15 2.1.4 Coverage for women aged 50 to 64 years (which is measured over a five and a half years to reflect the five year recall interval), fell to 78.4% at 31 March This compares to 79.4% at 31 March 2014 (see Table A). Coverage amongst women aged 25 to 49 years (measured at three and a half years) fell to 71.2% at 31 March 2015 from 71.8% the previous year (which had been the first rise in coverage for women in this age group since 2011). Table A: Cervical screening Coverage by age group England at 31 March, 2005 to 2015 Percentages Coverage (%) Year years less than 3.5 years since last adequate test * years less than 5.5 years since last adequate test * years (age appropriate) less than 3.5 / 5.5 years since last adequate test* years (5 year) less than 5 years since last adequate test ** *Coverage at 31 March 2013 excludes some women from a small number of LAs. ** This represents the older definition of coverage taken from the KC53 return (see paragraph 2.1.1) Source: KC53 return (5 year coverage) and Open Exeter (age appropriate coverage). Health and Social Care Information Centre. See also Tables 1, 1a and 13 in Data Tables section Figure 2 illustrates a more detailed age breakdown and shows that although coverage amongst women aged 25 to 29 years (measured at three and a half years) increased slightly to 63.5% at 31 March 2015 from 63.3% in 2014, it was still considerably lower than in any other age group. Less than two out of three women aged 25 to 29 years had been screened in the last three and a half years. Coverage amongst women aged 50 to 54 (which is measured over a five year period) was highest at 80.8%. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 15

16 Figure 2: Cervical screening coverage* by age group England, at 31 March, 2014 and 2015 Percent (coverage <3.5 yrs since last test) (coverage <5 yrs since last test) *Age appropriate coverage in the age group (as measured at five and a half years) is not currently available for the more detailed age bands. As such this chart shows the breakdown under the previous definition (as measured at five years) Source: KC53, Health and Social Care Information Centre. See also Table 1a in Data Tables section Age-appropriate coverage of the full target age group (25 to 64 years) at a regional level at 31 March 2015 ranged from 68.4% in London to 76.3% in the East Midlands. All reporting regions reported a fall in coverage at 31 March 2015 when compared with 2014 (see Table B). Table B: Age appropriate coverage for women aged years England regions, 31 March 2014 and 2015 Percentages Age appropriate coverage (Less than 3.5 / 5.5 years since last adequate test) Region North East Yorkshire & the Humber North West East Midlands West Midlands East of England London South East South West Source: Open Exeter (age appropriate coverage), Health and Social Care Information Centre. See also Table 13 in Data Tables section. 16 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

17 2.1.7 Age appropriate coverage was 75% or higher in 63 of the 150 LAs - see Figures 3 and 3a. Figure 3: Cervical screening Age appropriate coverage of the target age group (25-64) Upper Tier Local Authority, England, 31 March 2015 Number of Local Authorities % 60 60% 65 65% 70 70% 75 75% 80 80% Age Appropriate Coverage (% aged 25-64) Source: Open Exeter - PHOF, Health and Social Care Information Centre. See also Table 13 in Data Tables section. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 17

18 Figure 3a: Cervical screening Age appropriate coverage of the target age group (25-64) Upper Tier Local Authority, England, 31 March 2015 Source: Open Exeter - PHOF, Health and Social Care Information Centre. See also Table 13 in Data Tables section. NB: Due to rounding, the figures presented in the above map may not exactly match those derived from aggregating the relevant columns from Table 13 in the Data Tables section. At a local level, 118 Local Authorities (out of 150) had coverage levels of 70% and above (see Figure 3a). For detailed figures on coverage at LA level see Table 13 in the Data Tables. Please also note that age appropriate coverage figures for LAs are available from Public Health England via the following link: 18 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

19 2.1.8 The test status of the population as at 31 March 2015, together with women with recall ceased for clinical reasons 9, is shown in Table C. Of women aged 25 to 64 years, 73.0% were recorded as having had a least one adequate test within 5 years. A further 7.4% were tested within ten years. 9.5% had been called but had never attended for screening. Table C: Test status of women aged England at 31 March 2015 Thousands and Percentages Women resident Women ceased for clinical reasons within the last 1.5 years more than 1.5 up to 3 years Women who have been tested (time since last adequate test) more than 3 up to 3.5 years more than 3.5 up to 5 years more than 5 up to 10 years more than 10 up to 15 years more than 15 years Women called but not tested No adequate sample Never attended No cytology record Number (thousands) , , , , , Percentage NB: The sum of components may not equal totals due to rounding. Source: KC53, Health and Social Care Information Centre. See also Tables 2, 3 and 3a in Data Tables section Table D shows coverage in other UK countries. It should be noted that cervical screening programmes in other countries vary in terms of the age groups covered by the screening programmes, the frequency of screening and in how coverage is calculated. In comparing coverage in England to other countries, these differences (detailed in the footnotes) should be borne in mind. Coverage in Table D below is calculated for women aged 25 to 64 years for all countries with the exception of Scotland where it is calculated for women aged years. Table D: Cervical screening coverage United Kingdom by country at 31 March 2015 Thousands and Percentages Country Number of eligible women Number of women screened within specified target period Coverage (%) England 14,165.8 Northern Ireland Scotland 1,122.8 Wales , , Source for England figure: Open Exeter - PHOF, Health and Social Care Information Centre. See also Table 2 in Data Tables section. For both Northern Ireland and Wales, coverage is calculated as the percentage of women in a population eligible for screening at a given point in time who were screened adequately 9 Ceased for clinical reasons should indicate the women has no cervix. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 19

20 within the past 5 years. The Scottish and English programmes calculate coverage within the past 5.5 years. Data for each country can be found through the following links: Northern Ireland: Scotland: Wales: Invitations for screening There was an increase in the number of women aged 25 to 64 years invited for screening in compared with the previous year (see Figure 4 and Table E). In total, 4.31 million women aged 25 to 64 were invited in Most of these were women aged 25 to 49 (3.38 million) with women aged 50 to 64 accounting for 0.93 million of those invited. Figure 4: Number of women invited for screening, by age England, to Millions years years years Year Source: KC53, Health and Social Care Information Centre. See also Table 1 in Data Tables section. 20 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

21 Table E: Number of women invited for screening by year and age group England, to Numbers and Percentage Change Age group Change from to Total (all) 4,447,846 4,802,197 4,366,196 4,458,042 4,538, % Total (25-64) 4,328,471 4,692,227 4,235,069 4,244,755 4,311, % ,373,140 3,707,883 3,336,723 3,346,282 3,379, % , , , , , % NB: Figures prior to are derived from the PCO dataset. Source: KC53, Health and Social Care Information Centre. See also Table 4 in Data Tables section. Sum of components may not equal totals due to numbers screened outside the listed age groups The NHS Cervical Screening Programme categorises screening invitations into types as shown in Table F. Detailed explanations of the different types of invitation are given in Appendix C. Table F shows that although most women aged 25 to 64 years received a call 10 or routine recall, 8.4% were early repeat recalls for surveillance. The proportion of women who received an early repeat recall following an abnormality (i.e. persistent findings of borderline change or low-grade dyskaryosis) rose slightly to 2.9% in from 2.8% the previous year. Table F: Number of women (aged 25-64) invited in the year by type of invitation England, and Numbers and Percentages Repeat in less than 3 years for reasons of Year Total Call (%) Routine Recall (%) Surveillance (%) Abnormality (%) Inadequate sample (%) ,244, ,311, Source: KC53, Health and Social Care Information Centre. See also Table 4 in Data Tables section In total, 3.12 million women aged 25 to 64 years were tested in , a fall of 3.3% from when 3.23 million were tested (see Figure 5 and Table G). 10 Where the invitation type is call, this indicates that the invitation is a first call for screening. Women receiving this invitation type will not have been screened before. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 21

22 Figure 5 shows the number of women tested each year since (following the age and frequency changes to screening policy which were introduced in 2003 see section 1.4). The unexpected increase in women tested in has been associated with the diagnosis and death from cervical cancer of the high profile media personality, Jade Goody (Lancucki et al, 2012). Research published in the Journal of Medical Screening reported that her diagnosis and death, which were well publicized, were marked by a substantial increase in attendances in the cervical screening programme in England..(Although the) increase in screening attendances was observed at all ages..the magnitude was greater for women aged under 50 (Lancucki et al, 2012, p4). Women aged tested in would be expected to receive their next routine invitation for screening three years later in This may partly explain the second smaller peak in women aged 25 to 49 tested in The numbers of women tested in fell in both the and year age groups. Amongst women aged 25-49, 2.40 million women were tested in , a decrease of 3.7% from A total of 0.72 million women aged were tested in , a decrease of 2.2% from These falls may be explained by the introduction of HPV testing 11. Figure 5: Number of women tested, by age England from to Millions years years years Source: KC53, Health and Social Care Information Centre. See also Table 1 in Data Tables section. Year 11 See 2011 Cancer Strategy Impact assessment 22 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

23 Table G: Number of women tested by year and age group England from to Numbers and Percentage Change Age group Change from to Total (all) 3,442,808 3,646,360 3,394,266 3,298,399 3,190, % Total (25-64) 3,351,127 3,560,905 3,320,389 3,225,180 3,117, % ,551,660 2,736,974 2,561,077 2,493,714 2,402, % , , , , , % NB: Figures prior to are derived from the PCO dataset. Source: KC53, Health and Social Care Information Centre. See also Table 5 in Data Tables section Of those aged 25 to 64 tested in the year, over 2.55 million (81.9%) were tested following an invitation within the screening programme. The remaining 565,088 women (18.1%) had screening tests not prompted by the programme, i.e. test initiated by the sample taker or opportunistically by the woman, without her necessarily having been invited in the last six months by the screening programme 12 (see Table 5 in Data Tables) Some women may be routinely recalled by their GPs instead of through the screening programme and because of this it is not possible to calculate the percentage uptake of invitations from the national call/recall database. 2.3 Test results Some women have more than one test during the year for clinical reasons 13 and the 3.19 million women of all ages tested in generated 3.27 million tests (see Table H). In 2.6% of tests there was no result, as the sample was inadequate i.e. it did not contain material suitable for analysis (see paragraphs for more information on inadequate samples). Table H: Number of tests and result England, Numbers and Percentages Result of test Number of tests % Inadequate 86, Adequate 3,181, Total 3,267, Source: KC53, Health and Social Care Information Centre. See also Table 7 in Data Tables section. NB Adequate includes every other possible test result 12 Opportunistic tests will most commonly be taken from women who are overdue for screening. 13 This can be if the sample is inadequate or if a repeat test is required due to a previous abnormality (with or without treatment). Copyright 2015, Health and Social Care Information Centre. All rights reserved. 23

24 2.3.2 For women tested again due to an earlier inadequate test, 12.6% of tests resulted in a repeated inadequate result, an increase on (11.9%) see Table I. These repeated inadequate samples accounted for 10.6% (9,170 out of 86,227) of all inadequate results in the year. Table I: Result of test where a repeat invitation was sent in less than 3 years due to a previous inadequate sample England, and Numbers and Percentages Result of test Tests % Tests % Inadequate 8, , Adequate 62, , Total 71, , Source: KC53, Health and Social Care Information Centre. See also Table 7 in Data Tables section The NHS Cervical Screening Programme categorises the results of cytology tests as shown in Table J. Detailed explanations of the different types of cytology test result are given in Appendix D. Of the 3.10 million women aged 25 to 64 with adequate tests in , 93.6% had a negative result and 6.4% had a result categorised as abnormal (from borderline change through to potential cervical cancer 14 ). 1.3% of women tested in had a result showing a high-grade abnormality (i.e. a result of high-grade dyskaryosis (moderate), high-grade dyskaryosis (severe), high-grade dyskaryosis (severe)/?invasive carcinoma and?glandular neoplasia of endocervical type). Table J shows the breakdown of the results of adequate tests for the last 2 years. The new classification for abnormal cervical cytology introduced in April 2013 will have impacted on the results of cytology tests for onwards and in particular on the proportion of results classified as borderline and low-grade dyskaryosis (see section 1.7 on Changes in reporting and classification of cervical cytology of the Data Quality Statement which accompanies this publication for more information). 14 Potential cervical cancer includes high-grade dyskaryosis/?invasive squamous carcinoma and?glandular neoplasia of endocervical type. 24 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

25 Table J: Results of adequate tests for women aged England, and Numbers and Percentages Result of test * Total results 3,184,628 3,073,833 % % Negative Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) High-grade dyskaryosis/?invasive carcinoma** ?Glandular neoplasia** Total * Most severe result in year **?invasive carcinoma means suspected invasive carcinoma,?glandular neoplasia means suspected glandular neoplasia. NB: The sum of components may not equal totals due to rounding. Source: KC53, Health and Social Care Information Centre. See also Table 8 in Data Tables section Within the target age range, the percentage of results showing a high-grade abnormality decreased with age, being highest at 3.4% for women aged 25-29, falling to less than 0.5% for women aged 50 years and over (see Figure 6). Copyright 2015, Health and Social Care Information Centre. All rights reserved. 25

26 Figure 6: Cervical screening - Test results showing a high-grade abnormality as a percentage of all test results, by age group of women England Age Percent NB. Note that the percentages in Figure 6 are aggregates of four test result groups (high-grade dyskaryosis (moderate), high-grade dyskaryosis (severe), high-grade dyskaryosis (severe)/?invasive carcinoma and?glandular neoplasia of endocervical type.) Source: KC53, Health and Social Care Information Centre. See also Table 8 in Data Tables section In 120 of the 150 LAs, the proportion of women presenting with an abnormal result was between 4% and 8%. In 5 LAs the proportion was 10% or above (the maximum was 13.5%) (see Figure 7). 26 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

27 Figure 7: Cervical screening Percentage of tests for women aged with an abnormal result Upper Tier Local Authority, England, Number of LAs Percentage of tests with an abnormal result NB: The percentages in Figure 7 are aggregates of six test result groups (borderline change, low-grade dyskaryosis, highgrade dyskaryosis (moderate), high-grade dyskaryosis (severe), severe/?invasive carcinoma and,?glandular neoplasia of endocervical type). Source: KC53, Health and Social Care Information Centre. See also Table 12 in Data Tables section. 2.4 Time from screening to receipt of results National policy is that all women should receive their cervical screening test result within two weeks of the sample being taken. Time from screening to receipt of results is defined as the interval between the date the sample was taken from the woman and the date she received her result letter. It is measured using an expected delivery date based on the date of letter printing and the postage class used by the screening department In , 91.0% of letters to women tested were reported to have an expected delivery date of within 2 weeks of the sample being taken. This compares to 93.7% in (see Table K) and is below the Key Performance Indicator current acceptable value of 98.0% Time from screening to receipt of test results as measured by expected date of delivery is calculated from summing monthly data for local authorities. 16 NHS public health functions agreement Service specification no.25 Cervical Screening Copyright 2015, Health and Social Care Information Centre. All rights reserved. 27

28 Table K: Time from screening to receipt of results, as measured by expected delivery date of result letter (eligible women aged years) England, and Numbers and Percentages Total letters to women tested 3,132,432 3,280,913 Expected delivery date % % Up to 2 weeks More than 2 weeks and up to 3 weeks More than 3 weeks Source: National Cancer Screening Statistics VSA15 Report, HSCIC Open Exeter system (NHAIS). See also Tables 9 and 9a in Data Tables section At a regional level, the highest percentage of letters received within 2 weeks of results was reported in the North East (98.6%), with the lowest in Yorkshire & the Humber (81.5%). The North East is the only region to have met the Key Performance Indicator current acceptable value of 98.0% (see Figure 8) Figure 8: Cervical Screening Time from screening to receipt of results as measured by expected date of delivery of result letter (eligible women aged years), percentage received within 2 weeks England by region, and Region North East Yorkshire & the Humber North West East Midlands West Midlands East of England London South East South West Percent England (91%) Operational Standard (98%) Source: National Cancer Screening Statistics VSA15 Report, HSCIC Open Exeter system. See also Table 9a in Data Tables section. 28 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

29 Table 9 in the Data Tables section presents more detailed figures by region on time from screening to receipt of results. Table 9a in the Data Tables section presents the same figures at LA level. Local figures on time from screening to receipt of results broken down by month are available through the following link: Recall status There are three types of recall status within the NHS Cervical Screening Programme; normal recall, repeat recall and suspend recall. Normal recall status indicated by action code A, (routine recall) was previously used only where the test result was negative. With the roll out of HPV testing as triage for women with mild or borderline cervical screening test results 17, a woman may now be given a normal recall status following a test result of borderline change or low-grade dyskaryosis if the test was HPV negative (see section for more information). Repeat recall status, action code R, requires a further test which is usually earlier than routine recall. 18 This may be used where a test result is inadequate, negative (depending on a women s screening history), borderline change or low-grade dyskaryosis. Suspend recall status, action code S, is an indication that recall has been suspended due to referral to colposcopy. This is the only allowable status following a test result of high-grade dyskaryosis (moderate) or worse. It is also used for women who are referred after repeated inadequate or low-grade abnormalities (i.e. borderline change or low-grade dyskaryosis) and for women who are to remain under hospital care regardless of their test result. With the roll out of HPV triage it is also used for women with borderline/low-grade cytology and HPV-positive test results In , almost all women with an inadequate test result (96.9%) had a repeat recall status (See Table L). Amongst women who had nothing other than a negative test result in the year, 91.8% had a normal recall status. Of the remaining women with negative results, 6.9% had a repeat recall status as they were under surveillance or follow-up and 1.3% had a suspend recall status as they were under hospital care For more information on HPV triage, see Changes in Screening Policy under section NB: The next test can be up to 36 months if a fixed 3 year repeat is required after treatment. 19 Those with a negative test result and suspend recall status could include some who were referred to colposcopy due to symptoms noted at the time of testing. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 29

30 Table L: Recall status by most severe screening result England, Percentages Recall Status Screening result Normal (A) Repeat (R) Suspend (S) % % % Inadequate Negative Borderline changes Low-grade dyskaryosis High-grade dyskaryosis (moderate) High-grade dyskaryosis (severe) High-grade dyskaryosis/?invasive carcinoma* ?Glandular neoplasia (endocervical)** NB: The sum of components may not equal totals due to rounding. - = recall status not applicable for this result *?invasive carcinoma means suspected invasive carcinoma, **?glandular neoplasia (endocervical) means suspected glandular neoplasia of endocervical type Source: KC53, Health and Social Care Information Centre. See also Table 10 in Data Tables section Figures 9a and 9b show the recall status for women with borderline and low-grade test results over the last ten years and highlight the impact of the roll-out of HPV testing which began in March Prior to HPV testing most women with a first borderline screening result would have had a repeat recall status. In , 70.4% of women fell into this category. Now, where HPV testing has been implemented, women with a borderline result are tested for high risk HPV and depending on the result either returned to normal routine recall or referred to colposcopy and given a suspend recall status. In , comparatively few (4.1%) were given repeat recall status see Figure 9a. The change following the introduction of HPV testing is less pronounced for women with lowgrade dyskaryosis screening results but the increase in the proportion of women with a normal recall status and the fall in the proportion with a repeat recall status is still evident see Figure 9b. 30 Copyright 2015, Health and Social Care Information Centre. All rights reserved.

31 Figure 9a: Recall status for women with borderline screening results England, to Percent HPV testing rollout begins - March 2012 Borderline changes Suspend (S) Normal (A) Repeat (R) NB: Figures prior to are derived from the PCO dataset. Source: KC53, Health and Social Care Information Centre. See also Table 10 in Data Tables section. Year Figure 9b: Recall status for women with low-grade screening results England, to Percent Low-grade dyskaryosis Suspend (S) Normal (A) Repeat (R) Year NB: Figures prior to are derived from the PCO dataset. Source: KC53, Health and Social Care Information Centre. See also Table 10 in Data Tables section. Copyright 2015, Health and Social Care Information Centre. All rights reserved. 31